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Drug Induced Liver Injury - Symptoms, Treatment & Recovery

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Medically Reviewed by Dr. Aman Priya Khanna
Written by Sangeeta Sharma, last updated on 17 July 2023| min read
Drug Induced Liver Injury - Symptoms, Treatment & Recovery

Quick Summary

  • Drug induced liver injury (DILI) is prevalent, and almost all medicines may cause this condition
  • In most instances, the drug induced liver injury is not severe and improves once the medication causing it is discontinued
  • To find out the drug that causes liver injury in an individual, it is essential to watch out for the symptoms and get medical help immediately to prevent further complications

Drug induced liver injury (DILI) is prevalent, and almost all medicines may cause this condition. In most instances, the drug induced liver injury is not severe and improves once the medication causing it is discontinued. But, to find out the drug that causes liver injury in an individual, it is essential to watch out for the symptoms and get medical help immediately to prevent further complications.

Medicines produce therapeutic effects and provide treatment, cure or management for various medical conditions. However, these medicines also induce side effects in an individual that can be as mild as nausea and vomiting or as severe as drug induced liver injury (DILI), which may become fatal. Please keep reading to learn about drug induced liver injury, its symptoms, treatment methods and recovery.

What is a Drug-Induced Liver Injury? 

  1. Drug induced liver injury (DILI) is an adverse reaction that occurs in response to drugs (medicines) or xenobiotics.
  2. Drug induced liver injury is otherwise also known as drug-induced hepatotoxicity. It can be caused by prescription, over-the-counter (OTC), and herbal and dietary supplements.
  3. Drug induced liver injury or hepatotoxicity may be acute or chronic, and it is responsible for causing frequent acute liver failure.

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Classification of Drug Induced Liver Disease

Drug-induced liver injury is usually classified into two types. These two types include:

  1. Intrinsic drug induced liver disease: Intrinsic drug induced liver injury or illness usually depends on the dose of the drug and is predictable—for example, acetaminophen toxicity.
  2. Idiosyncratic drug induced liver disease: Idiosyncratic drug induced liver injury or disease is not predictable and does not depend only on the dose. It is accountable for most drug-related hepatotoxicity.

Besides the dose and total drug exposure time, idiosyncratic drug-induced liver injury also depends on the uncommon response of the patient receiving it. Examples of medicines (drugs) that can cause idiosyncratic drug induced liver injury include using antimicrobial treatments, Amoxicillin-clavulanate. 

Potential Risk of Developing Drug-Induced Liver Injury

The occurrence of drug induced liver disease is usually dependent on the interactions between the drug (medicine), the patient (host) and the environmental risk factors. This includes the following:  

  1. The factors related to drugs (medication) that increase the risk of drug-induced liver injury include:
    1. The dose of the drug
    2. The route of drug administration
    3. The duration of administration of the drug
  2. People who are at an increased risk of developing drug-induced liver injury include the following:
    1. Female sex 
    2. Children 
    3. Elderly people
    4. Genetic factor
    5. People with compromised immunity 
    6. People with acute liver damage 
    7. Patient with a history of previous drug-induced liver injury 
    8. People having Non-alcoholic fatty liver disease (NAFLD) 
  3. Environmental risk factors that increase or put an individual at risk of developing drug induced liver injury (DILI):
    1. People who are obese or have obesity 
    2. Dietary habits of the person 
    3. Alcohol consumption 
    4. Tobacco usage 
    5. People who are on multiple drug therapy 
    6. Excessive consumption of caffeinated drinks 

Drugs that cause Drug-Induced Liver Injury or Drugs Induced Hepatotoxicity

Many drugs are known to cause liver injury. These drugs include over-the-counter (OTC) medicines, prescription medicines and even herbal and dietary supplements. Examples of some drugs inducing hepatotoxicity or causing liver injury include the following:

  1. Antibiotics: Drugs like Amoxicillin-Clavulanate, Ciprofloxacin, Isoniazid (INH), Erythromycin, and Ciprofloxacin are some antibiotics that are known to cause drug-induced liver injury. Antibiotics are responsible for causing 45.4% of idiosyncratic drug-induced liver injuries. 
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs): Diclofenac, Ibuprofen, Mefenamic acid, etc., are NSAIDs known for inducing liver injury or hepatotoxicity. 
  3. Cardiovascular drugs: Drugs like statins (atorvastatin, pentostatin) or amiodarone are examples of cardiovascular drugs that cause hepatotoxicity or liver injury.  
  4. Herbal and dietary supplements (HDS): HDS are responsible for about 16.1% of hepatotoxicity or liver injury. Examples of Herbal and nutritional supplements (HDS) that induce liver injury include green tea extract, multi-ingredient dietary supplements and anabolic steroids.
  5. Central nervous system (CNS) drugs: Drugs acting on the CNS, like valproate and phenytoin, are responsible for causing liver injury. 
  6. Anticancer agents or antineoplastic medicines:
    1. Methotrexate: It is an immunosuppressant that slows the immune system and aids in the reduction of inflammation.
    2. Tyrosine kinases inhibitors: They inhibit the proliferation or multiplication of tumour cells, hence used to treat cancer. Examples include Erlotinib and Gefitinib.
    3. Tumour necrosis factor inhibitors inhibit the body's response to tumour necrosis factor (TNF- helps the body fight infections), which is part of the inflammatory response, resulting in stopping inflammation. Examples include Infliximab, Adalimumab.
    4. Alpha inhibitors: ( which lower blood pressure) like Doxazosin, Prazosin, and Terazosin are some anticancer or antineoplastic drugs known for producing hepatotoxicity or liver injury. 

Symptoms of Drug Induced Liver Injury 

Usually, drug induced liver disease symptoms appear about 3 to 6 months after the drug administration. They may vary from person to person. Where the symptoms are mild or chronic in some instances, some people don’t experience any liver injury symptoms at all. 

However, the symptoms indicating drug-induced liver injury include the following:

  1. Jaundice 
  2. Dark urine 
  3. Abdominal pain
  4. Nausea or vomiting
  5. Diarrhoea 
  6. Fatigue
  7. Fever
  8. Itching on the skin (pruritis)
  9. Headache 
  10. Loss of appetite

Diagnosis of Drug Induced Liver Injury 

Diagnosing drug induced liver injury is difficult. This is because most of the patients don’t experience any symptoms at all. And the ones who share it may not know that it is caused due to liver injury as the symptoms they experience are similar to other conditions. 

However, depending on the symptoms being experienced by the patient, the healthcare provider may suggest some of the following tests:

  1. A complete medical history examination
  2. Blood tests to check the level of liver enzymes
  3. Imaging tests like ultrasound and Computed tomography (CT) scans to get a detailed view of the liver.
  4. Liver biopsy

Treatment for Drug Induced Liver Injury 

The first treatment approach used to treat drug-induced hepatotoxicity is to stop the consumption of the drug causing it and avoid its exposure. A doctor may also use other treatment approaches to treat drug induced hepatotoxicity. These treatment approaches are as follows: 

  1. Using N-acetyl-cysteine (NAC) to treat the intrinsic drug-induced liver injury caused by acetaminophen toxicity.
  2. Using L-carnitine to treat the drug-induced liver injury caused by an overdose of valproic acid.
  3. Glucocorticoid therapy to treat liver damage due to autoimmune hepatitis.
  4. Bile acid sequestrants for cholestatic drug-induced liver disease.
  5. Antihistamines for treating itching (pruritus).
  6. Hospitalisation in patients showing signs of progression of drug-induced liver injury.
  7. Liver transplant in severe conditions where the liver is extensively damaged.

However, consult the doctor if you are facing any symptoms associated with drug induced hepatotoxicity to get the proper treatment at the right time. Do not self-treat yourself, as it can further worsen your condition.

Recovery from Drug Induced Liver Injury 

The time taken to recover from drug induced hepatotoxicity typically depends on the drug that has caused it. Usually, the patient with drug-induced liver injury starts recovering in a few days to a week after cessation of the drug therapy.

However, the recovery might also be quick in some instances, whereas it may take a few weeks to months to recover entirely in others. 

Takeaway

Drug induced liver injury (DILI) is an adverse reaction that usually depends on the interactions between the drug (medicine), the patient (host) and the environmental risk factors. It is highly prevalent, and almost all medications may cause drug-induced liver diseases. In most instances, the drug-induced liver injury is not severe and improves once the medicine causing it is discontinued. 

If you or your loved ones have doubts or symptoms associated with drug-induced liver injury, contact our team of experts at HexaHealth. Our expert team of doctors can consult you and provide you with the proper treatment. Get in touch with us TODAY!

Frequently Asked Questions

Yes, in case of mild drug induced liver injury, you may recover in a few weeks as soon as you stop taking medicine causing it. However, in the case of chronic drug-induced liver injury, it may take a few weeks to months for you to recover.

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The time it takes for a liver injury to heal and recover from drug-induced liver injury or drug-induced hepatotoxicity typically depends on the drug that has caused it. Usually, the patient with drug-induced liver injury starts healing and recovering in a few days to a week after cessation of the drug therapy. In some instances, the healing and recovery might be quick, whereas in certain cases, it may take a few weeks to months.

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A liver injury can be healed by getting it treated. The treatment includes removing the cause, like the medicine or drug causing it. Apart from that, lifestyle changes like maintaining a healthy weight, reducing alcohol intake and avoiding tobacco consumption can help speed up healing. In case of chronic liver injury, a liver transplant may be needed. 

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Yes, acute liver injuries can be reversed in some instances with an appropriate treatment approach. However, a liver transplant might be the only option for obtaining a complete cure. 

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There are sure signs and symptoms that you might observe and which might indicate that your liver is healing. These signs of a healing liver include: 

  1. Improved energy
  2. Improved ability to think clearly 
  3. Less pain 
  4. A stable weight 
  5. Improved appetite 
  6. The skin and eye colour are back to normal 
  7. Enhanced blood work 
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Drug-induced liver injury, or drug-induced hepatotoxicity, is treated by:

  1. Removing the drug causing the liver injury 
  2. Symptomatic treatment 
  3. Hospitalisation in patients showing signs of progression of drug-induced liver injury 
  4. Liver transplantation in severe conditions
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During drug-induced liver injury, hepatocellular destruction occurs. This may cause pain in the abdomen, nausea, vomiting, jaundice and, in severe cases, even death.

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If the liver damage is acute, then it may be curable; however, in the case of severe liver damage, it is primarily curable. 

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The drug-induced liver injury occurs in response to drugs (medicines) or xenobiotics. Drug-induced liver injury is otherwise also known as drug-induced hepatotoxicity. It can be caused by prescription, over-the-counter (OTC), and herbal and dietary supplements.

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Drug-induced liver injury is usually classified into two types. These types include intrinsic drug-induced liver injury and idiosyncratic drug-induced liver injury.

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Drug-induced hepatotoxicity occurs in response to drugs (medicines) or xenobiotics. Drug-induced hepatotoxicity is otherwise also known as drug-induced liver injury. It can be caused by prescription, over-the-counter (OTC), and herbal and dietary supplements.

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The occurrence of drug-induced liver injury (DILI) is usually dependent on the interactions between the drug (medicine), the patient (host) and the environmental risk factors.

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The most common causes of liver injury include drug-induced liver injury, excessive alcohol consumption, and hepatitis infection.

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During liver injury, the following liver enzymes are elevated or increased:

  1. Alanine transaminase (ALT)
  2. Alanine transaminase (ALT)
  3. Aspartate transaminase (AST)
  4. Gamma-glutamyl transferase (GGT)
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Last Updated on: 17 July 2023

Disclaimer: The information provided here is for educational and learning purposes only. It doesn't cover every medical condition and might not be relevant to your personal situation. This information isn't medical advice, isn't meant for diagnosing any condition, and shouldn't replace talking to a certified medical or healthcare professional.

Reviewer

Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

12 Years Experience

Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More

Author

Sangeeta Sharma

Sangeeta Sharma

BSc. Biochemistry I MSc. Biochemistry (Oxford College Bangalore)

6 Years Experience

She has extensive experience in content and regulatory writing with reputed organisations like Sun Pharmaceuticals and Innodata. Skilled in SEO and passionate about creating informative and engaging medical conten...View More

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